BackgroundNecrotizing enterocolitis (NEC) is a devastating gastrointestinal emergency with significant mortality and morbidity rates. A subset of patients progressed rapidly and underwent surgical intervention within a short period. This study aimed to establish a model to predict the rapid progression of NEC in preterm neonates.MethodsA retrospective study was conducted to review neonates with NEC between December 2015 and April 2019 at the Guangzhou Women and Children's Medical Center. Rapidly progressive NEC was defined as the need for surgical intervention or death within 48 h of NEC onset. Patients were divided into two groups: rapidly progressive NEC (RP-NEC) and non-rapidly progressive NEC (nRP-NEC). Data on demographics, perinatal characteristics, examination variables, and radiographic findings at onset were collected.ResultsA total of 216 preterm neonates with NEC were included in the study, of which 64 had RP-NEC and 152 had nRP-NEC. The mortality rates of patients with RP-NEC and nRP-NEC were 32.8% and 3.28%, respectively. Male sex (p-value, adjusted odds ratio [95% confidence interval]: 0.002, 3.43 [1.57, 7.53]), portal venous gas (0.000, 8.82 [3.73, 20.89]), neutrophils <2.0 × 109/L (0.005, 4.44 [1.59, 12.43]), pH <7.3 (7.2 ≤ pH < 7.3) (0.041, 2.95 [1.05, 8.31]), and pH <7.2 (0.000, 11.95 [2.97, 48.12]) at NEC onset were identified as independent risk factors for RP-NEC. An established model that included the four risk factors presented an area under the curve of 0.801 with 83% specificity and 66% sensitivity.ConclusionAmong preterm neonates with NEC, a significantly higher mortality rate was observed in those with rapid progression. It is recommended that close surveillance be performed in these patients, and we are confident that our established model can efficiently predict this rapid progression course.

Background: Previous studies reported contradicting results about the association between the absolute lymphocyte count and necrotizing enterocolitis. The aim of this study was to explore whether the absolute lymphocyte count of (ALC) can be a biomarker for neonates with necrotizing enterocolitis needs surgical consultation. Methods: We retrospectively analyzed perinatal data, clinical features before NEC onset (T0), laboratory values at T0 and at the time within the 24h after NEC onset(T1) from neonates with confirmed NEC who were admitted to Guangzhou Women and Children’s Medical Center from January 2016 to June 2021. Univariate and multivariate logistic regression analyses were used to evaluate predictive factors of surgical NEC. Receiver operating characteristics analysis was used to evaluate cutoffs and predictive values. Results: Overall, 224 neonates with NEC were identified, including 80 cases (35.7%) underwent surgical intervention (surgical NEC) and 144 cases (64.3%) were managed with conservative treatment (medical NEC). Multivariate Logistic regression analysis showed that male gender [p value, adjusted odds ratio [95%CI]; 0.002, 3.36(1.53-7.35)], low ALC on T1[(<0.001, 0.37(0.25-0.55)] were identified as independent risk factors for surgical NEC. The area under curve (AUC) of ALC on T1 was 0.814 (95% CI 0.757~0.871). The optimal cut-off value was 2.10*109/L with 80% sensitivity and 74% specificity. Conclusion: In neonates with NEC, low ALC may indicate a higher probability of needing surgical intervention. Timey surgical consultation may assist in the early diagnosis of the surgical NEC and avoid missing the optimal timing of surgery.